三维重建模拟经皮拉力螺钉固定髋臼前柱骨折的解剖学研究
The anatomic study of percutaneous lag screw fixation for anterior column fracture in acetabulum in virtual three-dimensional reconstruction model
目的 测量髋臼前柱的解剖参数,评估术前拉力螺钉固定髋臼前柱的风险。方法 收集155例成人骨盆CT扫描数据,其中男91例,女64例,重建骨盆三维模型。应用MIMICS软件在髋臼前柱置入虚拟螺钉,测量虚拟螺钉的最大直径、长度、进钉点,并计算虚拟螺钉方向。垂直髋臼前表面虚拟截骨,测量每个截骨面的内外径、上下径。计算髋臼前柱在真骨盆缘MN段的弧度。结果 髋臼前柱允许置入虚拟螺钉的最大直径和长度在男性为(7.95±0.98)mm和(124.84±6.79)mm,女性为(6.42±1.15)mm和(120.00±7.52)mm; 虚拟螺钉与水平面和矢状面的夹角在男性为(21.55±2.67)°、(42.15±2.54)°,女性为(21.85±5.10)°、(41.51±5.23)°; 前柱MN段的弧度在男性为(38.29±3.28)°,女性为(43.41±3.50)°。以上数据除进钉方向外男女间均有显著差异。螺钉直径与性别、前柱弧度线性相关,相关系数分别为-0.468、 -0.164。女性髋臼前柱置入直径为6.50 mm、7.00 mm螺钉的风险分别是男性的9.081倍、13.316倍。结论 对于中国人,建议使用直径为6.50 mm的拉力螺钉固定髋臼前柱骨折,当女性髋臼前柱弧度大于(44.49±2.47)°时,宜行钢板内固定。
Objective To assess the risk of lag screw fixation for anterior column by measuring the applied anatomy parameters of the acetabular anterior column. Methods CT scan data of 155 (91 males and 64 females) cases of adult pelvis were obtained and virtual three-dimensional model were reconstructed by software MIMICS. Virtual screws were placed in the anterior column of the acetabulum,then the maximum diameter, length, entrance point of the screws were measured and the direction of the screws were calculated. The virtual cuts was made perpendicular to anterior surface of acetabulum , then the inner-outer and vertical diameter of anterior column was measured respectively. The arc of the anterior column of acetabulum in the edge of true pelvic was calculated. Results In the men, the maximum diameter and length of virtual screws were (7.95±0.98) mm and (124.84±6.79) mm, In the women, the values were (6.42±1.15) mm and (120.00±7.52) mm. In the men, The angles between screws and horizontal plane (the screw pointed caput), sagittal plane(the screw pointed outside) were (21.55±2.67)° and (42.15±2.54)°; In the women, the values were (21.85±5.10)° and (41.51±5.23)°. In the men, The arc of the segment MN of anterior column was (38.29±3.28)°, which was (43.41±3.50)° in the women. All data presented statistical significance between men and women except the direction of virtual screws. There was linear correlation between screws diameter and gender, the arc of the anterior column, and the correlation coefficients were -0.468 and -0.164, respectively. The risks of the female received anterior column fixation by screws6.5mm and 7.0mm in length were 9.081 and 13.316 times greater than the male, respectively. Conclusions The lag screw of 6.5 mm in diameter is strongly recommended for fixating the anterior column fracture of the acetabulum in Chinese people. For female, when the arc of the acetabular anterior column is more than (44.49±2.47)°, plate fixation should be considered.
髋臼前柱 /   / 拉力螺钉固定 / 应用解剖 / 三维重建
Acetabular anterior column / Lag screw fixation / Applied anatomy / Three-dimensional reconstruction
[1] Laird A, Keating JF. Acetabular fractures:A 16-year prospective epidemiological study
[J].J Bone Joint Sur Br,2005,87(7):969-973.
[2] Ochs BG, Marintschev I, Hoyer H, et al. “Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group(DAO/DGU)”
[J]. Injury, 2010,41(8):839-851.
[3] 王辉, 祖罡, 毕大卫, 等. 经皮逆行髋臼前柱螺钉的临床应用
[J]. 中国骨伤, 2012, 25(10):807-809.
[4] Carmack DB, Moed BR, McCarroll K, et al. Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography
[J].J Bone Joint Surg Am, 2001, 83
[9]:1370-1375.
[5] Ebraheim NA, Xu R, Biyani A, et al. Anatomic basis of lag screw placement in the anterior column of the acetabulum
[J].Clin Orthop Relat Res,1997, (339):200-205.
[6] 蓝旭, 梁军,文益民, 等. 髋臼骨折手术并发症分析
[J].中国现代手术学杂志, 2007, 11(5):374-377.
[7] Giannoudis PV, Nikolaou VS. Surgical techniques-How do I do it? Open reduction and internal fixation of posterior wall fractures of the acetabulum
[J]. Injury, 2008, 39(10):1113-1118.
[8] Lin YC, Chen CH, Huang HT, et al. Percutaneous antegrade screwing for anterior column fracture of acetabulum with fluoroscopic-based computerized navigation
[J]. Arch Orthop Trauma Surg,2008, 128(2):223-226 .
[9] Gras F, Marintschev I, Wilharm A, et al. 2D-floroscropic navigated percutaneous screw fixation of pelvic ring injuries--a case series.BMC Musculoskeletal Disorders. 2010,11:153. doi: 10.1186/1471-2474-11-153.
[10]王先泉, 张伟, 孙水, 等. 髋臼前柱拉力螺钉技术内固定的临床解剖学研究
[J].中国临床解剖学杂志, 2007, 25(2):143-147.
[11]陈凯宁,王钢,曹良国, 等. 髋臼前柱骨折经皮逆行拉力螺钉固定的三维重建模型研究
[J]. 中华骨科杂志, 2009, 29(3):257-262.
[12]刘照华,王大平, 熊建义. 髋臼前柱骨折重建钢板内固定的临床解剖学
[J]. 中国临床解剖学杂志,2009, 27(6):658-662.
[13]郭世绂. 骨科临床解剖学
[M]. 济南.山东科学技术出版社,2001:362-363.
[14]常希会,尹维刚,史增元,等. 髋臼前柱骨折后入路拉力螺钉内固定应用解剖及临床应用
[J]. 中国临床解剖学杂志, 2011, 29(3):260-264.
[15]Ceylan H, Selek O, Sarlak AY. Percutaneous fixation of anterior column acetabular fracture in a renal transplant recipient
[R]. Case Rep Orthop,2013.
[16]Chang JK, Gill SS , Zura RD, et al . Comparative strength of three methods of fixation of transverse acetabular fractures
[J]. Clin Orthop Relat Res, 2001,(392):433-441.
重庆市科委(cstc2012gg-yyjs0205); 重庆市渝中区科委 (20110311)
/
〈 |
|
〉 |